8/20/2021 Jack AMPS 107 Skipped dose and 4 hrs later 451

Daddy Jack's Mommy (GA)

Daddy Jack's Mommy (GA)

Member Since 2019
Yesterday's post https://www.felinediabetes.com/FDMB...65-8-82-9-5-142-pmps-345.251665/#post-2839791

This is day #5 on Levemir after switching from 3 months of Prozinc. He had his first green number yesterday since coming out of remission in May. Hmm... I think I'm just going to skip this dose. I had to feed him without stalling because he started throwing up from being hungry. Stalling Jack is never an option. What would you do? (He's SLGS.)
 
I don't know what to do here. After looking over some other SSs, I can see that kitties are dosed on lower numbers than I'm used to seeing. I WANT him to stay in the greens and blues, but what should I do with a 107? He was consistently in the reds, at AMPS, just a few days ago on Prozinc. I really need some advice.
 
Daddy Jack's Mommy said:
Yesterday's post https://www.felinediabetes.com/FDMB...65-8-82-9-5-142-pmps-345.251665/#post-2839791

This is day #5 on Levemir after switching from 3 months of Prozinc. He had his first green number yesterday since coming out of remission in May. Hmm... I think I'm just going to skip this dose. I had to feed him without stalling because he started throwing up from being hungry. Stalling Jack is never an option. What would you do? (He's SLGS.)
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Usually with SLGS, you can shoot any number over 90. But that's after you have experience and data on your cat. The other thing to keep in mind is that with Levemir, you get nadirs towards the end of the cycle and you get used to shooting lower preshots. You still have a few hours before the onset of this dose.

Even though you do not have enough data on Levemir, you have experience with low numbers. Can you monitor today if you shoot?
 
Bandit's Mom said:
Usually with SLGS, you can shoot any number over 90. But that's after you have experience and data on your cat. The other thing to keep in mind is that with Levemir, you get nadirs towards the end of the cycle and you get used to shooting lower preshots. You still have a few hours before the onset of this dose.

Even though you do not have enough data on Levemir, you have experience with low numbers. Can you monitor today if you shoot?
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I can't monitor well enough because my daughter has a doctors appointment. I will be out of the house for a few hours (it's a good distance). Should I just give him a reduced dose? Maybe 1/2 (2.5U)? Would that make sense?
 
I think I may just shoot a token dose of 2U, so that he isn't without any insulin on board. I would feel better if I could be with him to monitor, but I can't. I never expected him to react so strongly to the switch. I'm thrilled, but I'm wondering if I maybe should lower his dose and then take it from there (as I gather some data and see how he reacts). I go back to work on Monday, after a 2 week vacation, and I won't be with him all day.:(
 
I'm just going to skip. I'll feel more comfortable with that. I need to get more data and see how he reacts with Levemir. It's a whole new ball game. I may lower his dose tonight - maybe as low as 3U, and take it from there. I can move him quickly up the scale as I need to.
 
tiffmaxee said:
The thing you need to get used to with lev is the nadirs can be at shot time o very late in the cycle. I would not reduce. @Wendy&Neko please comment when you see this. I would have skipped or actually shot a token dose this morning.
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I can't wait to become more comfortable with Levemir. I want to bring his numbers down but I get nervous! I just tested his BG, an hour and a half after he ate like he was starving, and it's now 273. My only problem with not lowering the dose is that I won't be with him during the day beginning on Monday. But I don't want to set him back.
 
Darn work! Maybe lower it but not such a big drop. From 5.25 to 3.0 is a huge drop. See what Wendy suggests. Do you have an auto feeder?
 
tiffmaxee said:
Darn work! Maybe lower it but not such a big drop. From 5.25 to 3.0 is a huge drop. See what Wendy suggests. Do you have an auto feeder?
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I don't have an auto feeder, but most days my daughter is here to feed him. He would never make it through the day without eating! He takes his food very seriously. I'm curious to see what Wendy says about dropping the dose. I know she suggested keeping the dose the same as his prozinc dose when the vet told me to drop it to only 1U when I made the switch. :eek:
 
Arrgggg!!! Now I'm seeing 451 4 hours after he's eaten. What have I learned? I've learned NOT to miss doses on Levemir even with an AMPS of 107. I should have given him a token shot this morning. I hope I didn't mess with how well he was doing and how well the Levemir was already working on him. I'll shoot him early this evening, maybe 4U? Would 5U be better? What do you think? I was/am so sad to see another blasted red! @tiffmaxee @Bandit's Mom @Wendy&Neko

Edited to add: And he's probably bouncing like crazy, just like Wendy said (yesterday) he would.
 
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Yes, a token dose this morning, the 2.0 units you were thinking of, would have helped out. What you saw this morning was probably the result of the 5.5 unit depot, not so much from the 5.25 dose you shot last night. And yes, you can shoot anytime tonight if you want to shoot earlier, since it's been 12 hours.

I personally got really used to shooting even the 50's with Levemir, but I was following TR and had more data by then. You might want to try getting some +1 tests this weekend, just to get an idea what happens the hours after you shoot. You also have to consider that you are not shooting the number at preshot time, but rather where the BG will be at onset. With Neko's onset at +5, I had plenty of time for her numbers to rise before the next insulin shot took effect. With Jack, it does look more like three hours for onset.

As for dose tonight, I personally would do 5.0 units, but if you want to be cautious, you could always go back to 4.5 units and see what that does. I'd feel more confident about suggesting 5.0 units while you are at work, if your daughter could test him.
 
Wendy&Neko said:
Yes, a token dose this morning, the 2.0 units you were thinking of, would have helped out. What you saw this morning was probably the result of the 5.5 unit depot, not so much from the 5.25 dose you shot last night. And yes, you can shoot anytime tonight if you want to shoot earlier, since it's been 12 hours.

I personally got really used to shooting even the 50's with Levemir, but I was following TR and had more data by then. You might want to try getting some +1 tests this weekend, just to get an idea what happens the hours after you shoot. You also have to consider that you are not shooting the number at preshot time, but rather where the BG will be at onset. With Neko's onset at +5, I had plenty of time for her numbers to rise before the next insulin shot took effect. With Jack, it does look more like three hours for onset.

As for dose tonight, I personally would do 5.0 units, but if you want to be cautious, you could always go back to 4.5 units and see what that does. I'd feel more confident about suggesting 5.0 units while you are at work, if your daughter could test him.
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His PMPS was 482, and I shot 5U. I'll get this yet!
 
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